Mixed messages. That’s what we’re getting. Or, put another way, the hits just keep on coming.
As you read these words, roughly 60.5 million people in the U.S. are 65 years of age and older. Just under 2%, 1.2 million residents, are in skilled nursing facilities. According to The Silver Book from the Alliance for Aging Research, in 2030, the 65+ population in the U.S. will be more than 71 million. If that 2% number, referring to those in SNFs, holds true, that is more than 1.42 million.
This means that 1.4 million people will need to live in one of roughly 15,600 SNFs in the U.S. If things stay the same, though, the number of SNFs in the U.S. will shrink. Indeed, 550 SNFs went out of business between 2015 to 2019, and that was before the Covid-19 pandemic.
More Reasons for Shrinking SNF Census Numbers
But that’s only if these numbers are unaffected by other factors. The ethos of aging in place is very much in play here. More and more seniors want to stay home for as long as possible. And who can blame them? But it does put downward pressure on census numbers for SNFs.
Many senior care facilities, especially SNF’s, continue to grapple with shrinking census numbers in the aftermath of the pandemic. According to an article in the N.Y. Times, more than 181,000 residents of SNFs, assisted living and other long-term care facilities died from Covid-19. Families fearing for their loved ones in these facilities sought other arrangements, most of the time moving them into a family member’s home. Added to that, many hospitals were stopping all elective surgeries during the worst of the pandemic. These surgeries, including knee and hip replacements, were the very kind that created the post-acute patient that needed a short-term stay in an SNF to recover fully. That’s more income lost.
According to the same N.Y. Times article, by Q4 of 2020, the occupancy rates of SNFs were down to 75%, a drop of 11 percentage points from Q1.
There Are More Challenges for Senior Providers
According to Holland & Knight, an international law firm with a specialty in senior and senior-care issues, senior healthcare providers could be facing a perfect storm: a cut in benefits of as much as 9% this year. This includes the expiration of a 3.75% payment boost to help get through Covid-19, a 2% Medicare sequester, and as much as 4% for cuts to pay for the American Rescue Plan pay-as-you-go rules (the latter of which is likely not to happen given recent events in Congress).
It is a small wonder that in September of 2021, only 25% of the 15,600 SNFs in the U.S. expressed confidence that they would survive the pandemic and the other challenges facing the industry, as reported on the 19th website, an independent, nonprofit online newsroom reporting on senior issues.
Ramifications Far Beyond Senior Care
When a senior requiring care lives at home with the family, there are other considerations, though.
One of the long-time inequities of Medicare is that the funding that helps maintain a senior in an SNF does not follow them if they opt for aging in place. And hiring a caretaker, even at the minimum wage rates most of them make, can be a burden to the family.
With no other options, the responsibility of care inordinately falls upon the female member of the household. This means she most likely cannot work outside the house. Now the labor pool is affected.
This affects the economy in other ways, too. Empty nesters now caring for an aging parent are limited in their ability to go out to dinner, enjoy a vacation, or participate in other recreational activities. Restaurants, recreation, and other business sectors also feel the pinch of the SNFs.
The burnout rate of aging in place or living with family is also very high and devastating to the caretakers.
The Burnout Rate and the Silver Tsunami
“People don’t realize all that goes into the day-to-day care,” said Meegan Lambert, an assistant professor of occupational therapy at North Central College. Lambert was interviewed for an article in The 19th. She noted that a typical nursing home has a dietary staff to prepare three hot meals daily, nurses to administer medications throughout the day, and others to facilitate social activities.
“One or two family members might have to do what it takes a whole village to do,” she added. “They can quickly become burnt out with trying to meet the emotional, social and physical needs of their loved one.”
A lot is riding on the ability of the senior care industry to continue operating.
The reality is that none of us, including CMS, can ignore the “silver tsunami” that is cresting over the United States. Despite aging in place, despite the pandemic, and despite other trends, there will be seniors who need quality SNF care. A quick look at the demographics reveals this. The 85+ population is expected to triple by 2050. There will have to be a reckoning between all those involved.
The Solution for Senior Care Providers
Many have already pointed to this reckoning. With potential cutbacks in reimbursement and additions to the five-star rating system, CMS may very well set itself up for confronting the reality. This observation was expressed in a CareWork blog posted last week. David Grabowski, professor of healthcare policy at Harvard Medical School, was speaking during a LeadingAge call with industry stakeholders, as reported by McKnight’s Long-Term Care News. He said, “That’s not something nursing homes can fix on their own. I really believe we need more reimbursement from Medicaid and Medicare to make that happen.”
Mark Zimmet, CEO of Zimmet Healthcare Services Group, voiced a similar opinion. In an executive outlook reported on earlier this month for Skilled Nursing News. Zimmet maintains that CMS is acting on faulty data. He stated, “The pandemic exposed structural issues within the SNF economic model. While the government provided interim relief, there is no quick fix to the escalating, enduring staffing crisis and inflationary profile of general operating costs. Comprehensive reimbursement reform is desperately needed, but rational policy cannot be developed without accurate information. To that end, I’m hoping 2022 is the ‘Year of Good Data.’”
Good Data is Also an Internal Issue for Many
SNFs and other senior care facilities can’t count on all the answers coming from CMS, though. They need to look internally and use data to run a more efficient operation. The challenge is that senior care as an industry was a latecomer to technologically produced data, and when it did come, it evolved in a haphazard manner. Information is contained in separate programs or silos that don’t interface with each other for a complete picture. Areas such as staffing and scheduling, census, admissions, purchasing, and care often do not blend for a fuller picture.
Carework, however, makes this integration possible. CareWork gives you the information you need to manage the staffing levels as your census changes, so you have the right number of people on the right shifts and are not paying unneeded overtime.
CareWork provides you a complete picture of admissions. The sources that are referring residents, trends around which diagnosis are being admitted, average length of stay, and hospital readmissions. Armed with this knowledge you can seek even more referrals. You can also see the reasons why patients are not coming to your facility. It might be worth the investment to add some services. Many SNFs are adding in-house dialysis units, physical rehab suites, private rooms, and other amenities.
CareWork Enables Accurate Reporting
CareWork also allows you to process this information into the reports that CMS and other regulatory bodies want to see. And because the information is all in one place, the reports are accurate. Even today, many SNFs are piecemealing information from several different sources. This is a recipe for errors that could cost you a five-star rating with CMS. Worse yet, you could accidentally inflate the numbers and get caught in an audit. With CareWork, you have an accurate report of where you are, and it is only seconds away.